Psoriasis – symptoms, causes and treatment

Symptoms of psoriasis

The most common symptom is well-defined, red patches on the skin covered with white or silvery scales. These patches most often appear symmetrically on the elbows, knees, lower back, and scalp, but can occur anywhere on the body. Many people experience itching and flaking skin, which typically worsens during cold, dry weather.

• Nail psoriasis: Manifests as pitting, discoloration, or loosening of the fingernails and toenails. It is present in up to half of all people with psoriasis.
• Scalp psoriasis: Causes severe scaling and flaking, and is frequently confused with severe dandruff or seborrheic dermatitis.
• Guttate psoriasis: Appears as many small, teardrop-shaped red patches over large areas of the body. It is most commonly seen in children and adolescents.
• Inverse psoriasis (in the skin folds): Occurs under the breasts, in the groin, and between the buttocks. It lacks the typical scaling and is easily confused with fungal infections or eczema.
• Psoriatic arthritis: In some patients, the condition affects the joints. Psoriatic arthritis causes pain, swelling, and stiffness—most commonly in the fingers, toes, and spine. It is erosive, meaning it can cause permanent joint damage if not detected and treated in time.

Causes of psoriasis

Psoriasis is an immune-mediated condition. The immune system triggers an inflammatory reaction in the skin that significantly accelerates the turnover of skin cells. These immature cells accumulate on the surface, forming the characteristic plaques.

The condition has a strong hereditary component. If both parents have psoriasis, the risk of inheriting it is up to 50%. Because it shares a genetic basis with other autoimmune conditions, psoriasis is now considered a systemic inflammatory condition - not just a skin issue.

A number of factors can trigger or worsen psoriasis. Streptococcal (strep) throat infections are a common trigger, especially for guttate psoriasis in children and adolescents. Stress, certain medications (including beta-blockers and lithium), skin trauma, smoking, and obesity are all well-documented aggravating factors. Cold, dry weather typically worsens the condition, while sunlight improves symptoms for most people.

Examination and diagnostics

Psoriasis is diagnosed clinically by a dermatologist based on your medical and family history, as well as the appearance of your skin and nails. In most cases, the diagnosis can be confirmed through a clinical evaluation alone. In cases of doubt—or if a fungal nail infection needs to be ruled out—a skin biopsy may be performed.

The severity is assessed based on how much of the body surface area is affected:

• Mild psoriasis: Covers less than 3% of the skin surface.
• Moderate psoriasis: Covers 3–10% of the skin surface.
• Severe psoriasis: Covers more than 10% of the skin surface.

Approximately one-quarter of all patients have moderate to severe psoriasis. Because psoriasis can easily be confused with seborrheic dermatitis, lichen planus, and fungal infections, an accurate diagnosis is essential for choosing the right treatment.

If there are any signs of joint involvement (such as morning stiffness, swollen fingers or toes, or spinal pain), the diagnostic process will include a rheumatological evaluation, blood tests, and imaging. Nail psoriasis is a strong marker for an increased risk of psoriatic arthritis and should always prompt an assessment of your joints.

Treatment of psoriasis

While there is no permanent cure for psoriasis, highly effective options exist to achieve long-term improvement and symptom control for all levels of severity.

For mild to moderate psoriasis, topical treatments are the first choice. Combination creams containing a vitamin D analogue and a corticosteroid are the evidence-based starting point. Daily skin care with a rich moisturizer is also an essential part of the treatment. Scalp psoriasis is treated with specialized prescription shampoos, gels, or ointments, as over-the-counter products are rarely sufficient.

For moderate to severe psoriasis, or when topical treatments are not effective, we will ensure you are referred to the appropriate specialized facility. Advanced options may include phototherapy (light therapy) or biologic medications. We ensure you move forward with a clear, professional assessment and treatment plan.

When should you seek medical attention?

We recommend consulting a dermatologist if you develop red patches on your skin that are persistent or spreading, if itching and flaking interfere with your sleep or daily life, if you notice changes to your nails, or if over-the-counter treatments have not worked within four to six weeks. Psoriasis in children should be evaluated early, as it is frequently confused with other childhood skin conditions.

If you experience signs of joint involvement—such as pain, swelling, or stiffness in your fingers, toes, or back—you should act quickly. Psoriatic arthritis can cause permanent joint damage if treatment is delayed.

Psoriasis at Charlottenlund Private Hospital

At Charlottenlund Privathospital, our dermatologists offer comprehensive evaluations and individually tailored treatment plans for all forms of psoriasis—including plaque psoriasis, nail psoriasis, scalp psoriasis, guttate psoriasis, and psoriasis in children.

A unique advantage of our hospital is that we have leading specialists in both dermatology and rheumatology under one roof. This enables seamless, coordinated care when psoriasis and psoriatic arthritis occur simultaneously.